Musculoskeletal Spine Flashcards
Disk Herniation
- Common mechanism of injury = twisting and bending of the spine. Typically with external load
- Nucleus pulposus bulges through the exterior wall of annulus fibrosis
- Typically posterior lateral portion of the disk (where it is the weakest)
- Often will compress nearby nerve roots
- Symptoms: LBP, unilateral (or B) leg pain, numbness, tingling, and weakness in nerve distribution affected.
- Symptoms exacerbation with sitting, walking, standing (things that increase intrabdominal pressure)
- Eval: Neural provocation testing, strength, sensation, DTR
Degenerative Spondylolisthesis – Degenerative
- Forward slippage of one vertebrae on the vertebrae below.
- Caused by weakening of joints that allows for forward slippage of one vertebral segment of the one below due to degenerative changes.
- Segmental ligamentous instability and subluxation of the hypertrophic facet joints which can result in stenosis of the spinal canal
- Most common level is L4-5 and causes cauda equina symptoms secondary to stenosis.
- Over 50 y/o; African American; women
- S&S: Back pain, sensory and motor loss
- Increases with exercise, lifting overhead, prolonged standing, getting out of bed or a car, walking up stairs or an incline and positioning in extension.
- Pretty much teach core stabilization and activity modification. Utilizing external support such as bracing to relieve intradiscal pressure.
- Will have increased lumbar lordosis and hamstring tightness, potentially waddling gait
orthopedic condition that mimics L5-S1 disk herniation
piriformis syndrome
Which areas of the spine are most susceptible to osteoarthritis?
lower cervical and lower lumbar
The areas of the spine most susceptible to osteoarthritis are the lower lumbar and lower cervical regions. Degeneration of the facet joints and the presence of osteophytes may combine with osteoarthritis to reduce the size of the intervertebral foramen leading to stenosis.
Scoliosis
- Lateral curvature of the spine quantified by the Cobb method.
- 3 classifications: functional, neuromuscular, and degenerative
- Girls and boys have similar risk —- though girls have greater risk of having curvature >30 deg.
- Pain is typically not associated with the spinal curvature….it is a result of the abnormal forces on the other tissues.
What are the 3 classifications of scoliosis
- Functional
o Leg length discriepancy, m imbalance, poor posture
o Nonstructural since the curves are flexible and correct with lateral bending - Neuromuscular
o Structural scoliosis
o Developmental pathology – alterations in the structure of the spine. (seen with Marfan or CP) - Degenerative
o Normal aging process and facilitated by changes such as osteophyte formation, bone demineralization, and disk herniation.
Grades of scoliosis and what to do with them
- <25 deg – should be monitored every 3 months. Teach breathing exercises, strengthening program for pelvic and trunk m.
- 25-40 deg – requires spinal orthosis and PT. Teach posture, flexibility, strengthening, respiratory function, and use of the orthosis.
- > 40 deg – surgical spinal stabilization by posterior spinal fusion and stabilization with Harrington rod
- > 60 deg causes pulmonary insufficiency, significant pian, impairment in lung capacity, and degenerative changes such as arthritis and disc pathology.
Spinal stenosis - Lumbar
- Narrowing of either the lumbar vertebral or intervertebral foramina
- Symptoms are caused by the mechanical compression of the spinal cord or exiting nerve roots.
- Age is the primary risk factor for secondary spinal stenosis.
- S&S:
o gradual onset and worsening of chronic midline LB pain.
o Unilateral nerve root radiculopathy, paresthesia, weakness, and decreased reflexes.
o Rarely get B&B problems - Symptoms are exacerbated lumbar extension and alleviated by rest and activities with lumbar flexion.
- Many pts will have stooped posture and may need AD to support this position.
- PT – help improve muscular support
- May get lumbar laminectomy to open up the space.
What motions feels better for disk herniation?
Extension
often experience diminished symptoms with extension of the spine since the motion results in the migration of the nucleus pulposus toward the center of the disk
What motions feel better and worse for facet arthropathy?
All movements tend to hurt and they are localized. Especially 3D type movements with SB, rotation, et.
Flexion tends to relieve symptoms due to the gapping in the facet joints.
Thoracic and Lumbar ROM
Flexion: 80
Extension: 25
Lateral flexion/SB: 35
Rotation: 45
How to diagnosis Osteoporosis
If the t-score is 2.5 standard deviations below the norm
difference between the reference population and the patient
Pelvic Crossed Syndrome (aka Lower crossed)
TIGHT:
- erector spinae
- ilipsoas
- rectus femoris
WEAK:
- Rectus abdominus
- external oblique
- glut max
Workplace ergonomics while on computer
1) monitor screen top slightly below eye level
2) body centered in front of the monitor and keyboard
3) forearms level or tilted up slightly
4) lower back support by chair
5) wrist free while typing
6) thighs horizontal
7) feet resting flat on the floor
Spondylolisthesis
- congenital defect of the pars interarticularis (scotty dog)
- Anterior slippage of superior vertebrae on the inferior vertebrae
Grade 1: 1-25%
Grade 2: 26-50%
Grade 3: 51-75%
Grade 4: 76-100% - Avoid extension exercises this will exacerbate symptoms.
- Perform core stabilization.
